I am an emergency physician on staff at Lenox Hill Hospital in New York City, where I have practiced for the past 10 years. I also serve as an adviser to Medscape Emergency Medicine, an educational portal for physicians, and an affiliate of WebMD. My other time is spent with my private house call practice called DR 911, providing medical care to both travelers and residents in Manhattan. I have a keen interest in medical technology and public health education.

2013 Flu Season: How to Protect Yourself

Based on recent reports from the CDC, the flu has started to peak nearly 5 weeks early this year, with significant activity reported in over 41 states with 18 deaths reported in children thus far. The predominant current flu strain that is being reported with widespread activity, H3N2 (Influenza A), appears to have good match to the flu strains in this year’s vaccine. H3N2 appears to be a virulent flu strain, which was also seen in the 2003-2004 season, based on reports from the CDC. Flu season usually begins in November, then begins to peak in late January or early February in a typical year. There is no clear reason for its early apparent peaking this season compared with last year, but this may portend a potentially dangerous season to come.

It’s good news if you have already been vaccinated so far this season. But if you have not already had the vaccine, it is still recommended that you get vaccinated. Overall, vaccination is your best protection against getting the flu. That said, it is still possible to get the flu, (a different circulating strain), but the chances are much less likely. The CDC recommends flu shots for everyone over 6 months of age. However, according to the CDC, only about 37 % of people in the US have been vaccinated this season, which is about the average in a typical year.

The flu vaccine is comprised of killed or inactivated virus (three most likely strains of flu virus based on predictions from the previous flu season). It takes about 2 weeks to build up immunity (antibodies) to influenza after you have had the flu shot. It is theoretically possible to still come down with the flu during this window period while your body is producing antibodies to the vaccine. It is important to note that you do not get the flu after receiving a flu shot. You may experience body aches and minor fatigue for about a day, however, this is not the flu. Your body is simply responding to the virus by manufacturing antibodies to protect your system.

If you are over the age of 50, are pregnant, have asthma, diabetes, chronic lung disease (such as COPD or emphysema), you should get a flu shot. In addition, people who live with or care for those at high risk for complications from the flu, including healthcare workers, and household visitors of persons at high risk for complications from the flu should be vaccinated.

Those who should not be vaccinated include persons with a severe reaction to a previous flu shot, people who developed Guillain- Barre syndrome within 6 weeks of a flu shot, and children less than 6 months of age.

Egg allergy is actually not a contraindication to vaccination, according to recent changes in guidelines from the American Academy of Allergy Asthma and Immunology (AAAI). Dr. Mathew Greenhawt of the University of Michigan, and co- author of the last two AAAI practice parameters on providing influenza vaccine to egg allergic individuals, explains that this policy changed in the past 2 years after extensive studies have “convincingly shown no risk to the egg allergic individual, including the severely (anaphylactic) egg allergic type”. He goes on to state that “there is unequivocally, no risk for an egg allergic individual that is greater than the general population”. Greenhawt adds that “there is an egg free vaccine approved for individuals over the age of 18, but it is not necessary to give this on account of egg allergy”.

Those people who are currently ill with a fever should not receive the flu vaccine. They should wait until they recover to get vaccinated, so their bodies can optimally manufacture antibody to the vaccine.

The flu is a respiratory virus that strikes suddenly, often “hitting you like a ton of bricks” with sudden chills, a high fever ( up to 103F), muscle aches, headache, and back pain. A dry cough may be present along with overwhelming fatigue. Your systems are systemic in nature, as opposed to a “cold” which rarely has fever, and often has nasal congestion, sneezing and a runny nose. You should consult your physician if you feel you may have come down with flu like symptoms. You are actually contagious with the flu generally 1 day before you develop symptoms, and to up to 7 days after the onset of your symptoms. As a result, is is recommended that you stay home from school or work, so you do not spread the virus.

If you have to cough or sneeze you should cover your mouth with a tissue or cough into your shoulder or elbow to prevent spread of virus. Washing your hands with plenty of soap and water or using hand sanitizers with at least 60 percent alcohol is advised as well. Avoid touching your eyes, nose and mouth as this can spread the flu virus to others. Try to avoid close contact if you are ill with the flu or if others around you have flu like symptoms. Using nasal saline spray may help to reduce transmission to other and also protect yourself from catching the flu. Drinking plenty of fluids, taking acetaminophen or ibuprofen for fever and resting are recommended. If you develop difficulty breathing or shortness of breath, chest pain or abdominal pain, sudden dizziness, confusion or have persistent vomiting, you should seek medical attention immediately.

It is important to mention that individuals that already have the flu who then become more ill during the duration of the illness, (difficulty breathing, or shortness of breath) need to seek medical attention immediately in an emergency department, as the risk of secondary pneumonia rises with an abrupt deterioration of your condition.

If you have symptoms for under 48 hrs, there are antiviral medications (Tamiflu and Relenza) that may reduce the duration of symptoms including fever, as well as potential complications (pneumonia, otitis media in young children). Tamiflu is one which is widely prescribed by many physicians and has efficacy against Influenza A and B. The resistance against these medications appears to be low thus far this season.

Patients who are in high risk categories with confirmed or suspected influenza (children less than 2 years of age, adults > 65 years of age, patients with chronic medical problems such as asthma, diabetes, kidney disease, HIV or AIDS, pregnant or postpartum) should consider taking Tamiflu if they develop flu like symptoms. In fact, Tamiflu was recently approved for infants 2 weeks and older for treatment of influenza. Please consult your physician regarding any questions regarding whether you should be taking antiviral medications if you develop flu like symptoms.

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